Gastroparesis in Children

Gastroparesis – also known as delayed stomach emptying — is a condition in which the stomach muscles do not work properly and the passage of food from the stomach to the small intestine is slowed. This condition affects digestion and prevents the stomach from emptying or absorbing proper nutrition. Gastroparesis can affect people of any age, but children with this disorder may feel:

• Full all the time
• Very nauseous
• Pain, or vomit undigested food left in the stomach

While there isn't yet a cure for gastroparesis, in some cases, it gets better after a few months to years —  others may have it as a lifelong condition. But with proper management, medication, and diet, our specialists can help you and your child control their symptoms.

The most common symptom of gastroparesis is vomiting. Children with this condition often get sick late in the day — typically after a meal — and commonly vomit foods eaten several hours earlier. Other symptoms may include:

• Upper abdominal discomfort or pain
• Feeling full after small amounts of food
• Belching
• Heartburn
• Nausea
• Bloating
• Acid reflux
• Not wanting to eat
• Changes in blood sugar levels
• Weight loss resulting in malnutrition

It is important to contact your child’s doctor as soon as possible if you believe symptoms are concerning or increasing.

Unfortunately, experts don't yet know exactly what causes gastroparesis. Sometimes, damage to the vagus nerve — which helps manage the digestive tract – can result in gastroparesis. If the vagus nerve is damaged, it can’t send the signals to the stomach muscles to contract and push food into the small intestine, resulting in food staying in the stomach longer and pain to occur. Additionally, gastroparesis may appear after an infection.

Other risk factors include:

• Surgery — particularly fundoplication, a procedure that controls reflux in patients with gastroesophageal reflux disease (GERD)
• Medications, such as anticholinergics and certain chemotherapy drugs
• Congenital defects that affect the stomach or abdomen, such as gastroschisis, which cause a baby's intestines to stick out of the body
• Other underlying conditions, including type 1 and type 2 diabetes, hypothyroidism, neurologic disorders, or metabolic disorders such as Riley Day syndrom

Your child’s doctor will review their medical history, perform a physical exam, and then order one or more diagnostic tests to confirm the diagnosis. If your doctor suspects your child may have gastroparesis, they may order one or more of the following tests.

Gastric emptying scintigraphy

This nuclear medicine test uses an external scanner that tracks radioactive materials — eaten by your child in food — as they move through the digestive system. A four-hour emptying test has become the gold standard for diagnosis and is available here at Boston Children's Hospital. Experts are developing even newer tests for the evaluation of gastric emptying.

Antroduodenal manometry

An antroduodenal manometry test places a small, flexible tube (catheter) through the nose and into your child's stomach and small intestine to measure pressure. If your child has a gastrostomy (feeding tube), your physician may insert the catheter through that instead.

Wireless motility capsules

Your child swallows a capsule containing a tiny device that measures pH, temperature, and pressure levels as it travels through the digestive system. The capsule transmits real-time data to a monitor worn by the patient.

The first step in treating children with gastroparesis is to address any underlying conditions and stop any medications that may contribute to the problem. Other treatment options may include:

• Special diet: Your child's physician and dietician will develop a customized diet plan involving smaller and more frequent meal portions, softer foods, and easily digestible meals. With the help of your care team, you will learn how to choose the best foods, plan mealtimes, and balance eating with exercise.
• Medications to control nausea: Drugs called antiemetics may decrease nausea and vomiting, and may be provided to elevate symptoms.
• Medications to improve stomach emptying: Prokinetic drugs — medications that increases the movement of food through the GI tract — may improve stomach function in some children. Some medications like cisparide, domperidone, or Botox injection to the pylorus (the opening of the stomach into the small intestine) are only available through specialized programs like those at Boston Children's Hospital. These medications should be prescribed and managed by your child’s physicians.
• Pain control: We provide a multidisciplinary team to help control your child’s stomach pain and improve quality of life.
• Gastric electrical stimulation: This treatment involves surgically implanting a neurostimulator in your child's stomach. The device delivers mild electrical pulses to the stomach muscle to control nausea and vomiting.
• Surgical jejunostomy: In some children, gastroparesis is so severe that they cannot keep down any food or liquids. In these cases, a surgeon may need to place a jejunostomy (feeding tube) directly into your child's intestines so they get proper nutrition.

If we suspect that your child has gastroparesis, we will recommend motility testing to evaluate and diagnose the condition. Boston Children's Hospital is known worldwide for our advanced gastrointestinal motility testing services.

Many of our motility doctors are pioneers in the development of the newest, noninvasive tests. Once your child has been diagnosed, the team of experienced clinicians in Boston Children's Motility and Functional Gastrointestinal Disorders Center will work with you and your child to develop a personalized treatment plan that draws from the latest therapies and research available.